Gynecology

Endometrial Cancer

Etiology Type I (75%) Type II (25%) Endometrioid Estrogen exposure Preceded with hyperplasia Mean age 55y OCP is protective Serous Unrelated to estrogen p53 mutation Later age Poorer outcome Risk Factors ↑ Estrogen exposure Early menarche Late menopause PCOS Obesity Lynch syndrome Tamoxifen Estrogen only HRT OCP ⇒ ↓ Risk Presentation...

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Gynecologic Cancers

→ IM-Oncology

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Cervical Cancer

Risk Factors HPV Prevention HPV vaccine → 11-26y Pap smear >21y → Every 3y → Until 65y Pap smear + HPV testing → Every 5y Diagnosis Pap smear High-grade hyperplasia → Colposcopy → Biopsy Low-grade hyperplasia → Colposcopy → Biopsy ASCUS → HPV testing ⨁HPV → Colposcopy + Biopsy ⊖HPV → Repeat Pap in 6m ASCUS = Atypical squamous cells...

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Ovarian Cancer

Surface derived → From Ovary, Fallopian tube, Peritoneum tissue Serous (most common) Cystadenoma → cysts with ciliated cells Cystadenocarcinoma → Psammoma bodies Mucinous Cystadenoma → cysts with mucus secreting cells Cystadenocarcinoma → Pseudomyxoma peritonei Endometrioid Associated with endometrial carcinoma Brenner Resemble bladder (transitional), coffee bean nuclei Germ cell Dysgerminoma ↑LDH, Turner Yolk sac (Endometrial...

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Breast Cancer

Risk Factors Family history HRT in menopause Most common → Adenocarcinoma Presentation Early findings Asymptomatic Sudden mammography finding Mass Single Nontender Immovable Hard to touch Ill-defined margins Unilateral bloody nipple discharge → Intraductal papilloma Locally advanced findings Axillary lymphadenopathy Breast enlargement Pain Peau d’orange → Suggests inflammation Redness Thickening...

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Primary Amenorrhea

First pregnancy test! Definition No 2º sexual characteristics by 13y 2º sexual characteristics present but no menses by 15y Etiology 2º sexual characteristics ABSENT Gonadal dysgenesis Turner syndrome Swyer syndrome Premature ovarian failure Radiation/Chemo to ovary Central hypogonadism Hypothalamic/Pituitary insufficiency Constitutional growth delay Undernourishment Stress Hyperprolactinemia Exercise Cranial radiation...

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Polycystic Ovarian Syndrome

Risk Factors Familial Valproic acid Presentation Amenorrhea Irregular menses Infertility Hirsutism Androgenic alopecia Obesity Acne Metabolic syndrome Insulin resistance DM type 2 Acanthosis nigricans Atherogenic dyslipidemia Hypertension Diagnosis Rotterdam Criteria (2 out of 3) Polycystic ovaries on U/S Bilateral enlarged ovaries, multiple cysts Anovulation/Oligoovulation History of Amenorrhea Clinical/Biochemical hyperandrogenism...

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Uterine Abnormalities

Fibroids Etiology Leiomyoma → Smooth muscle and connective tissue Estrogen-responsive → Change with cycles Non-malignant Risk factors Estrogen-responsive Change with cycles Shrink with menopause Black > White Presentation Uterine bleeding Menometrorrhagia Anemia Mass effect Enlarged uterus Constipation Urinary retention/frequency Pain Dysmenorrhea Dyspareunia Diagnosis Physical exam Firm, nontender, irregular, enlarged...

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Contraception

Best Methods What’s in it? Duration The Good The Bad Implanon Progestin only 3 years Light period Breastfeeding Ok Irregular periods Weight gain IUD (Levonorgestrel) Progestin 5 years Light period ↓ cramps Breastfeeding Ok ↑ EP risk PID IUD (Copper) 10 years Breastfeeding Ok ↑ cramps/bleeds ↑ EP risk...

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Uterine Bleeding

PALM COEIN Structural Polyp Adenomyosis Leiomyoma (Fibroids) Malignancy Non-structural Coagulopathy Ovarian Dysfunction (AUB) Endometrium Iatrogenic (IUD) Not yet classified Abnormal Uterine Bleeding Type Description Etiology Menorrhagia Heavy bleeding Endometrial hyperplasia Uterine fibroid DUB IUD Hypomenorrhea Light bleeding/Spotting Hymen Cervical stenosis OCP Oligomenorrhea Menstrual cycle >35 d Pregnancy Menopause Anorexia...

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Menopause

Permanent loss of estrogen 48-52 years Average 12 months Symptoms Menstrual irregularity Sweating Hot flashes Mood changes Insomnia Anxiety/Irritability Poor concentration Dyspareunia Loss of libido Vaginal atrophy Vaginal pruritus Vaginal dryness Physical Exam Atrophic vaginitis ↓ Breast size Vaginal/cervical atrophy Diagnosis NO test needed! ↑FSH ↑LH ↑ Total cholesterol...

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PMS/PMDD

Symptoms Headache Breast tenderness Pelvic pain Bloating Irritability Low energy Diagnosis Menstrual Diary Premenstrual Dysphoric Disorder Symptomatic for 2 consecutive cycles First half symptom free; Second half with symptoms Dysfunction in life Treatment Limit coffee, alcohol, cigarettes, chocolate Exercise Severe → SSRI

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